Elevated Creatinine Concentration Research Articles

Spectrophotometric and chromatographic analysis of creatine:creatinine crystals in urine

Creatinine is the end product of the catabolism of creatine and creatine phosphate. Creatine phosphate serves as a reservoir of high-energy phosphate, especially in skeletal and cardiac muscle. Besides typical known changes in serum and urinary creatinine concentrations, rare cases associated with changes in serum and urinary creatine levels have been described in the literature in humans. These cases are mostly linked to an excessive intake of creatine ethyl ester or creatine monohydrate, often resulting in increased urine creatinine concentrations. In addition, it is known that at such elevated creatinine concentrations, creatinine crystallisation may occur in the urine. Analysis of crystals and urinary concrements, often of heterogenous chemical composition, may provide diagnostic and therapeutic hints to the benefit of the patient. The aim of the present work was to analyze urine crystals of unclear composition with microscopic and spectroscopic techniques.On routine microscopic analysis of urine, a preliminary suspicion of uric acid or creatinine crystals was expressed. The crystals were of a cuboid shape and showed polarization effects in microscopy. The dried urine sample was whitish-orange in colour, odourless and dissolved well in water. Protein concentration in dry weight (DW) urine was about 0.3 mg/mg. The measured zinc content in the studied sample was approximately 660 µg/g DW sample and copper content was approximately 64 µg/g DW sample. A lead signal of around 10 µg/g DW sample was also observed. UV–Vis analysis showed a maximum creatine peak around 220 nm, compatible with the spectrum of creatinine with a maximum peak of 230 nm. Using HPLC technique, an extreme high ratio of creatine to creatinine of about 38 was measured, which led to the conclusion of the occurrence of rare creatine crystals in urine.

Effect of Perfluorooctanoic Acid on Kidney Function in Diabetic and Non-‎‎Diabetic Male Guinea Pigs

Perfluorooctanoic acid (PFOA) is a synthetic fluor-surfactant chemical used widely in ‎products that resist oil, heat, grease, stains, and water. It is also used in producing other ‎fluoropolymers. The main sources of exposure to PFOA are water, soil, and animal-‎origin food (meat, fish, and dairy products). The aim of this study to evaluate the renal ‎function following oral gavage of sub-lethal dose of PFOA in diabetic and non-diabetic ‎guinea pigs. The experiment run for 4 weeks, total of 40 male guinea pigs, ‎‎(Cavia porcellus), were randomly selected and grouped into four equal groups. The first ‎group (G1) served as the negative control; 2nd group (G2) alloxan induced diabetic, 3rd ‎group (G3) non-diabetic was exposed to PFOA at 100 mg/kg BW orally/daily and 4th ‎Group (G4) was diabetic guinea pig exposed to PFOA at 100 mg/kg BW orally/daily. ‎Serum creatinine and histopathological alterations in the kidney tissue were evaluated. ‎Serum creatinine concentrations were significantly increased (P<0.05) in G3 and G4 ‎exposed to PFOA. High serum creatinine levels were suggesting impairment in kidney ‎function. Impaired kidney function was confirmed through histopathological changes ‎such as glomerular atrophy, severe necrosis, and degeneration of renal tubular epithelium ‎in guinea pigs that received PFOA in G3 and G4. In conclusion, the results confirmed ‎that PFOA was associated with renal damage and elevated creatinine concentrations in ‎diabetic and non-diabetic animals since PFOA itself can contribute to diabetes‎‎‎.

Pseudohypercreatininemia after surgery for aortic dissection: a case report

BackgroundElevated creatinine concentrations often indicate acute renal injury and renal biopsies are considered in this situation. However,pseudohypercreatininemia is potential cause of elevated creatinine concentrations, and invasive interventions should be avoided.Case presentationA 54-year-old woman underwent surgery for descending aortic dissection.Nine days postoperatively, her creatinine concentration increased from 1 mg/dl to 5.78 mg/dl (normal range, 0.47–0.7 mg/dl). Azotemia and hyperkalemia were absent and physical examination findings were unremarkable. Cystatin C concentration was 1.56 mg/l (normal range, 0.56–0.8 mg/l) and pseudohypercreatininemia was suspected. Testing with different reagents showed a creatinine concentration of 0.84 mg/dl. Immunoglobulin (Ig)G was markedly elevated, and creatinine and IgG fluctuated in parallel, suggesting the cause of the pseudohypercreatininemia. IgG4 was also elevated at 844 mg/dl. Immunosuppressive steroid therapy effectively decreased the IgG concentration and resolved the pseudohypercreatininemia.ConclusionsIn cases of elevated creatinine concentration with the presence of abnormal proteins, pseudohypercreatininemia should be considered. We report a rare case of pseudohypercreatininemia caused by polyclonal IgG.

Ureteroneocystostomy for treatment of struvite urolithiasis in a ferret.

To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. A 10-month-old spayed female ferret. The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.

Biochemical effects of some preservatives on Glycine max in adult male albino rats

The food insecurity problem in Nigeria is largely due to the inability to preserve food surpluses after harvest. Post-harvest loss of grains account for between 5-25% forcing farmers’ use of some pesticides. This study examines the Biochemical effects of some preservatives on Glycine max in adult male albino rats. Glycine max (soya beans) sample was collected from Keffi Area of Nasarawa state, divided into five groups and preserved with Aluminum Phosphide, Dichlorvos (sniper), Wood-ash and Pepper while the fifth group was kept without preservative. A total of 36 adult male albino rats were obtained from the animal house of the Federal University of Agriculture, Makurdi, and acclimatized for two weeks. They were separated into the group of six (6) each and fed with a dietary intervention for 8 weeks. Group 1 (normal control) was animals administered Feed+ Water, max without preservative, Group 2 animals administered Feed+Water+Feed+Glycine max preserved with Aluminium Phosphide, Group 3 animals administered Feed+Water+Glycine max preserved with Sniper, Group 4 animals administered Feed+ Water+ Glycine max preserved with Pepper, Group 5 animals administered Feed+ Water+ Glycine max preserved with Wood-ash and Group 6 animals administered Feed+ Water+ Glycine max. The liver, kidney functions, lipid profiles and presence of C-reactive proteins were evaluated according to standard methods. The results showed statistically significance at p ≤ 0.05 with group fed Glycine max with preservative having the highest (145.383±3.300b) serum sodium concentration. There were elevated urea, creatinine, AST, ALT, and C-reactive protein concentration amongst the test groups for most of the preservatives. The study concludes that common preservatives used in the preservation of Glycine max have significant effects on serum biochemical parameters. Hence, study recommends further research to determine residual content of preservatives after grains preservation.

Clinical Characterization and Outcomes of Patients with Hypercreatinemia Affected by COVID-19

The present study evaluated the clinical presentation and outcome of COVID-19 patients with underlying hypercreatinemia at the time of hospitalization. A retrospective observational study was conducted from the 23rd of March 2020 to the 15th of April 2021 in 1668 patients confirmed positive for COVID-19 in the Chest Disease Hospital in Srinagar, India. The results of the present study revealed that out of 1668 patients, 339 with hypercreatinemia had significantly higher rates of admission to the intensive care unit (ICU), severe manifestations of the disease, need for mechanical ventilation, and all-cause mortality. Multivariable analysis revealed that age, elevated creatinine concentrations, IL-1, D-Dimer, and Hs-Crp were independent risk factors for in-hospital mortality. After adjusted analysis, the association of creatinine levels remained strongly predictive of all-cause, in-hospital mortality (HR-5.34; CI-4.89-8.17; p ≤ 0.001). The amelioration of kidney function may be an effective method for achieving creatinemic targets and, henceforth, might be beneficial for improving outcomes in patients with COVID-19.

Effect of dietary resveratrol supplementation on growth performance, antioxidant capacity, intestinal immunity and gut microbiota in yellow-feathered broilers challenged with lipopolysaccharide

Resveratrol (RES) displays strong antioxidant and anti-inflammatory properties in protecting the animals from various stressors and inflammatory injuries, but its interrelationship with the gut microbiota remained largely unclear. This study was carried out to investigate the effects of dietary RES supplementation on growth performance, antioxidant capacity, intestinal immunity and gut microbiota in yellow-feathered broilers challenged by lipopolysaccharide (LPS). A total of 240 yellow-feathered broilers were randomly assigned to four treatment groups in a 2 × 2 factorial design. The broilers were fed with the control diet or control diet supplemented with 400 mg/kg RES, followed by challenge with LPS or the same amount of saline. Dietary RES supplementation significantly alleviated the decreases in the final body weight (BW), average daily gain (ADG), and ADFI induced by LPS (P < 0.05). LPS challenge significantly increased plasma concentrations of triglyceride, high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), and cortisol levels, but decreased triiodothyronine (T3) and insulin levels (P < 0.05). Dietary supplementation with RES significantly reversed the elevated creatinine concentrations and the decreased concentrations of T3 and insulin caused by LPS (P < 0.05). Moreover, dietary RES supplementation significantly increased plasma total antioxidant capacity (T-AOC) and catalase (CAT) activities and superoxide dismutase (SOD) and T-AOC activities in jejunal mucosa and reduced malondialdehyde (MDA) concentration in the plasma (P < 0.05). The reduction in the villus height to crypt depth ratio in duodenum, jejunum and ileum and the shortening of villus height in jejunum and ileum caused by LPS were also alleviated by RES treatment (P < 0.05). Furthermore, the increased concentrations of intestinal tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-1β caused by LPS were significantly decreased by RES treatment (P < 0.05). Dietary RES treatment increased the mRNA expression of claudin-1, claudin-5, occludin, and zonula occludens-1 (ZO-1), and decreased mRNA expression of IL-1β, IL-8, IL-17, and TNF-α after LPS challenge (P < 0.05). Dietary RES treatments significantly decreased the dominance of cecal microbiota, and increased the Pieiou-e and Simpson index. Moreover, dietary RES supplementation increased relative abundance of UCG_ 009, Erysipelotrichaceae, Christensenellaceae_R-7_group, Anaerotruncus, RF39, and Ruminococcus while decreasing the abundance of Alistipes at genus level. Spearman correlation analysis revealed that the microbes at the order and genus levels significantly correlated with indicators of growth performance, antioxidant capacity, and intestinal health. Collectively, dietary supplementation with 400 mg/kg RES could improve growth performance and antioxidant capacity, and modulate intestinal immunity in yellow-feathered broilers challenged by LPS at early stage, which might be closely associated with the regulation of gut microbiota community composition.

Ficus sur methanol leaf extract ameliorated doxorubicin-induced cardio-renal damage in Wistar albino rats

Doxorubicin is an effective and still-used antineoplastic agent. However, the clinical use of doxorubicin is marred by life-threatening cardiotoxicity and nephrotoxicity. Free radicals have been implicated in the toxicity of doxorubicin. The aim of this study was to determine the phytochemical contents and protective effects of methanol extract of Ficus sur (MEFS) in doxorubicin-induced oxidative damage in Wistar albino rats, using biomarkers of cardiac, renal functions and oxidative stress as indicators. Phytochemical analyses revealed that MEFS is rich in tannins, alkaloid, saponins, flavonoids, but low in steroids. Acute toxicity studies show that MEFS was non-toxic up to 5000mg/kg b.w of Wistar rats. Administration of doxorubicin led to a significant (P&lt; 0.05) increase in Creatine kinase (CK-MB), troponin, creatinine, urea and MDA concentrations. Sodium and potassium concentrations were not significantly (P&gt;0.05) affected. Cardiac and renal superoxide dismutase (SOD), catalase and glutathione (GSH) were also significantly reduced. Results also show that pre-administration of MEFS was cardio- and nephroprotective in doxorubicin oxidative damage as evidenced by significant (P&lt;0.05) reduction of elevated troponin, CK-MB, creatinine and urea concentrations. Concentrations of renal and cardiac SOD, catalase and GSH were also significantly (p&lt;0.05) increased by MEFS compared to doxorubicin-treated group. Cardiac and renal MDA concentrations were significantly reduced. It may be concluded that protective effects of MEFS on doxorubicin toxicity may be due to the antioxidant properties of MEFS.

Determinants of survival in patients with bladder cancer undergoing radical cystectomy: The impact of serum creatinine level.

Bladder cancer is one of the most common cancers in Europe and is mostly found in men. Cystectomy is the treatment for invasive tumors that infiltrate the muscle of the bladder. This procedure is associated with a large number of complications. Eligibility for surgical treatment is important, because surgery may shorten the patient's life. The main prognostic factor is the severity of the disease, but less specific factors can be very helpful in selecting the form of treatment. To identify and analyze factors affecting significantly the survival in patients undergoing radical cystectomy (RC). A retrospective analysis of a group of 129 patients treated at the Department of Urology and Urological Oncology of University Hospital in Wrocław (Poland) was carried out. Furthermore, information about the results of laboratory tests from the medical records (blood count, creatinine concentration, etc.) was obtained. The follow-up was performed twice during the postoperative period. The Kaplan-Meier method was used to determine overall survival (OS) curves and statistical significance was assessed using log-rank test. A statistically significant correlation between preoperative serum creatinine level and OS was found. The OS was significantly shorter in patients with higher serum creatinine levels (log-rank test; p = 0.002). The patients were divided into different groups to exclude the relationship between the elevated creatinine concentration and the local disease advancement. The analysis was performed in patients with and without hydronephrosis. In both groups, creatinine levels above the acceptable range were associated with a shorter survival. Due to the high perioperative mortality, mainly in patients with advanced disease, it is necessary to develop the qualification process for surgical treatment. The awareness of the relationship between elevated creatinine levels and worse prognosis seems to be helpful.

Effects of secnidazole-diminazene aceturate combination therapy on parasitaemia and serum biochemical profile after late treatment in Trypanosoma brucei brucei infected dogs

Relapse parasitaemia is a major setback in the chemotherapy of a late stage Trypanosoma brucei brucei infection. An aberrant serum biochemical profile resulting from a T. b. brucei infection in dogs has been attributed to multiple organ injuries resulting from the invasive nature of the organism. Therapy with diminazene aceturate alone has not been satisfactory. This study evaluated the effects of a secnidazole-diminazine aceturate (SEC-DA) combination therapy on parasitaemia and the serum biochemical profile after the late treatment of a T. b. brucei infection in dogs. Eighteen dogs were randomly assigned to 6 groups (n = 3) as follows: Group A: uninfected nor treated; group B: infected without treatment; group C: infected and treated with DA (3.5 mg/kg) (DA-monotherapy) intramuscularly (i.m.) once; group D: infected and treated with SEC (100 mg/kg) and DA (3.5 mg/kg); group E: in-fected and treated with SEC (200 mg/kg) and DA (3.5 mg/kg) and group F: infected and treated with SEC (400 mg/kg) and DA (3.5 mg/kg). Secnidazole was administered orally for 5 days while DA was given i.m. once in groups D–F. The dogs were infected with 5 × 10&lt;sup&gt;5&lt;/sup&gt; trypanosomes intraperitoneally and treatment started 14 days post-infection. The parasitaemia was monitored daily while the serum biochemical indicators were monitored 14, 21, and 28 days post-infection. The total aparasitaemia was achieved in the SEC-DA treated dogs 72 h post-treatment and in 86 h in the DA-monotherapy dogs. A relapse parasitaemia occurred in the DA-monotherapy dogs 17 days post-treatment. The SEC-DA combination therapy caused a significant (P &amp;lt; 0.05) decline in the hitherto elevated urea and creatinine concentrations, and the ALP, ALT, AST activities. Also, there was a significant (P &amp;lt; 0.05) increase in the previously decreased serum albumin in the SEC-DA treated dogs. In conclusion, secnidazole-diminazene aceturate combination therapy prevented the relapse parasitaemia and ameliorated aberrant serum biochemical profiles of T. b. brucei infected dogs after late treatment.

Polyphenolic compounds of amla prevent oxidative stress and fibrosis in the kidney and heart of 2K1C rats.

Amla (Emblica officinalis Gaertn.) is a natural source of antioxidants and possesses valuable medicinal properties. However, the protective effect of amla in the kidney of two‐kidneys‐one‐clip (2K1C) rats has not been explained sufficiently. This study was performed to evaluate the renoprotective effect of amla fruit powder (2.5% W/W) supplementation in kidneys of 2K1C rats. 2K1C rats increased the remnant kidney wet weight and also increased plasma creatinine and uric acid concentration compared to the control. Amla supplementation ameliorates elevated creatinine and uric acid concentration in plasma of 2K1C rats. Various oxidative stress indicators such as malondialdehyde, nitric oxide (NO), and advanced protein oxidation product (APOP) were also increased in plasma, heart, and kidney tissues in 2K1C rats that were also significantly brought down to normal level by amla supplementation. Moreover, the inflammatory cells entry and fibrosis in the 2K1C rat's tissues were prevented by amla supplementation. These research results suggest that amla may restore plasma antioxidant capacities and prevents oxidative stress, inflammation, and fibrosis in 2K1C rats. Taken these results as a base, clinical supplementation of dried amla powder in diet or juice to the CKD patients would be beneficial.

Predicting and Defining Steroid Resistance in Pediatric Nephrotic Syndrome Using Plasma Metabolomics

IntroductionNephrotic syndrome (NS) is a kidney disease that affects both children and adults. Glucocorticoids have been the primary therapy for >60 years but are ineffective in approximately 20% of children and approximately 50% of adult patients. Unfortunately, patients with steroid-resistant NS (SRNS; vs. steroid-sensitive NS [SSNS]) are at high risk for both glucocorticoid-induced side effects and disease progression.MethodsWe performed proton nuclear magnetic resonance (1H NMR) metabolomic analyses on plasma samples (n = 86) from 45 patients with NS (30 SSNS and 15 SRNS) obtained at initial disease presentation before glucocorticoid initiation and after approximately 7 weeks of glucocorticoid therapy to identify candidate biomarkers able to either predict SRNS before treatment or define critical molecular pathways/targets regulating steroid resistance.ResultsStepwise logistic regression models identified creatinine concentration and glutamine concentration (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 0.99–1.02) as 2 candidate biomarkers predictive of SRNS, and malonate concentration (OR: 0.94; 95% CI: 0.89–1.00) as a third candidate predictive biomarker using a similar model (only in children >3 years). In addition, paired-sample analyses identified several candidate biomarkers with the potential to identify mechanistic molecular pathways/targets that regulate clinical steroid resistance, including lipoproteins, adipate, pyruvate, creatine, glucose, tyrosine, valine, glutamine, and sn-glycero-3-phosphcholine.ConclusionMetabolomic analyses of serial plasma samples from children with SSNS and SRNS identified elevated creatinine and glutamine concentrations, and reduced malonate concentrations, as auspicious candidate biomarkers to predict SRNS at disease onset in pediatric NS, as well as additional candidate biomarkers with the potential to identify mechanistic molecular pathways that may regulate clinical steroid resistance.

BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018.

We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition. The guidelines include: (i) Guidance on risk assessment prior to PrEP; (ii) Baseline assessment; (iii) Dosing schedules; (iv) Monitoring; (v) Supporting adherence; (vi) Buying generic PrEP; and (vii) Cost-effectiveness. The guidelines are aimed at clinical professionals directly involved in, and responsible for, HIV prevention, and at community advocates and organisations responsible for supporting HIV prevention strategies in those at risk of HIV acquisition. A detailed review of the evidence base is included in Section 4. Sections 5 to 7 are intended to offer practical guidance in risk assessment, starting PrEP, ongoing management while on PrEP and stopping PrEP.

Pseudohypercalcemia in a patient with multiple myeloma and acute kidney injury; a case report

Here in this paper, we present a 60-year-old man admitted for generalized pain in his limbs and was finally diagnosed with multiple myeloma. He also underwent evaluation and treatments for his hypercalcemia (15 mg/dL). His calcium concentration did not respond well to different modalities and was along with a low parathyroid hormone (PTH) and elevated creatinine concentration (12 mg/dL). Further evaluations revealed normal ionized calcium which confirmed the diagnosis of pseudohypercalcemia. Multiple myeloma is a plasma cell neoplasm in which 10% of the patients suffer from true-hypercalcemia at the time of diagnosis. Pseudohypercalcemia is described as an elevated serum calcium concentration along with normal ionized calcium concentration and the absence of clinical symptoms of hypercalcemia. The cause of pseudohypercalcemia in multiple myeloma is due to the binding of calcium to increased abnormal immunoglobulins. The importance of this issue lies in the low PTH levels along with hypercalcemia and azotemia which is suggestive of pseudohypercalcemia.

The Case | Labile creatinine levels in a patient with breast cancer

The Case | Labile creatinine levels in a patient with breast cancer

Effects of thermal manipulation during late incubation period on post-hatch thermotolerance in ostrich

The effects of thermal manipulation (TM) during late ostrich embryonic development on hatchability, body weight, biochemical and hormonal changes, and the ability of hatching chicks to cope with thermal challenge in days 6-8 of age were examined. At 35 days of incubation, two hundred fertile eggs were weighed and divided into two equal groups with five replicates. The first group was exposed to 36.5°C and 25% relative humidity (RH) (control), while the second group was exposed to 38.5°C and 45% RH for 3 h daily in days 35-37 of incubation (thermal manipulation). At days 6-8 of age, the hatched chicks from each treatment were randomly divided into two groups: control group (exposed to 32 ± 1°C), and thermal challenge group (exposed to 40 ± 1°C for 3 h daily). Hatchability rate was significantly lower with high incubation temperature as compared to the normal incubation temperatures. Embryonic TM and thermal challenge in days 6-8 of age reduced significantly total protein, albumin, and triiodothyronin concentrations and elevated uric acid, creatinine, triglycerides, and glucose concentrations as compared with the control. The level of corticosterone was significantly higher in the thermal challenge group as compared to the control. In conclusion, exposing the ostrich embryos to TM (38.5°C) during late embryonic development induced physiological changes that may represent epigenetic adaptation to TM. The same mechanisms are employed for increasing the ability to improve thermotolerance post-hatch.

Can metformin be used safely in a patient with elevated creatinine concentration?

Can metformin be used safely in a patient with elevated creatinine concentration?

Comparison between ADVIA Chemistry systems Enzymatic Creatinine_2 method and ADVIA Chemistry systems Creatinine method (kinetic Jaffe method) for determining creatinine

Objective. The aim of this study was two-fold: Firstly, to compare the serum creatinine concentration measured by enzymatic method and uncompensated kinetic Jaffe method, and secondly, to compare the effects of certain interfering substances such as glucose, bilirubin, proteins, triglycerides and hemoglobin on creatinine measurement. Methods. The determination of serum creatinine concentrations by enzymatic method and uncompensated kinetic Jaffe method was performed on ADVIA® 2400 analyzer. The interfering substances were tested by adding solutions of interference to serum pool with low (62 μmol/L), medium (221 μmol/L) and elevated (486 μmol/L) creatinine concentration. Results. In the method comparison study, despite the fact that the correlation between both methods for determining serum creatinine is very good (r = 0.998, p < 0.001), the regression analysis revealed that the results are not transferable, as indicated by the slope and intercept, which are significantly different from 1 and 0, respectively. A positive bias of + 14.1% in the determination of serum creatinine by uncompensated kinetic Jaffe method was found, and when the creatinine value is lower than ∼ 180 μmol/L this difference or bis progressively increases. We found a significant positive interference due to proteins and glucose and a significant negative interference due to bilirubin by kinetic Jaffe method, and no interferences by enzymatic method were found. Conclusions. In conclusion, the enzymatic method is the best choice for determining serum creatinine with the ADVIA® 2400 analyzer.

Circulating intact parathyroid hormone is suppressed at 25-hydroxyvitamin D concentrations &gt;25 nmol/L in children

Vitamin D status is best reflected by circulating concentrations of 25-hydroxyvitamin D2 and D3 (25-OH-D). An adequate blood concentration of total 25-OH-D is commonly defined as that which maintains parathyroid hormone (PTH) within the normal range. Consensus from studies of adults with renal impairment indicates that 75 nmol/L of 25-OH-D maintains suppression of PTH. No similar consensus exists in children. We studied the correlation of PTH and 25-OH-D in 271 patients aged 2 months to 21 years (mean 11 years) in a tertiary care pediatric setting. Patients with renal impairment were excluded by elevated creatinine concentration and chart review. PTH did not significantly correlate with 25-OH-D concentrations >25 nmol/L. PTH was significantly elevated in specimens with <25 nmol/L of 25-OH-D (p=10-17). Using PTH suppression as indicator, these data suggest that 25-OH-D concentrations >25 nmol/L in children indicate vitamin D sufficiency.

Acute severe hypothyroidism is not associated with hyponatremia even with increased water intake: a prospective study in thyroid cancer patients

BackgroundHypothyroidism, commonly induced in preparation for radioiodine treatment of differentiated thyroid cancer, is a text-book cause for hyponatremia. Nausea, stress, and increased fluid intake associated with the treatment are expected to exacerbate hyponatremia.MethodsWe prospectively studied 212 (80% females) consecutive thyroid cancer patients for the incidence of hypothyroidism-induced hyponatremia and associated risk factors.ResultsMean(SD) age was 39.7(14.1) year, creatinine 82.0(20.8) μmol/l, TSH 141.6(92.0) mU/l, pre- and post-isolation sodium 139.5(2.3) and 137.8(3.0) mEq/l, respectively, and estimated fluid intake during isolation 9.7(6.2) L. Mild hyponatremia (≥130 mEq/l) was present in 18 patients (8.5%) and moderate hyponatremia (≥120 mEq/l) in 4(1.9%), 3 of the latter had elevated creatinine concentration and 2 were on diuretics. There was no significant correlation between post-isolation sodium concentration and TSH concentration (r = 0.03, p = 0.69) or estimated fluid intake (r = 0.10, p =0.17). There was significant correlation between post-isolation sodium concentration and age (r = −0.24, p < 0.0001) and creatinine concentration (r = −0.22, p = 0.001). Pre-post-isolation drop in sodium concentration was more in females (mean difference 1.21, p = 0.02). Compared to eunatremic patients, hyponatremic patients were more likely to have pre-isolation hyponatremia (9% vs. 0.5%, p = 0.03), elevated creatinine concentration (36% vs. 13%, p = 0.008), and to be on diuretics (23% vs. 1%, p = 0.0001).ConclusionsIn the setting of acute severe hypothyroidism: 1) clinically-important hyponatremia is uncommon; sodium concentration may not need to be monitored unless patients have impaired renal function or are on diuretics, 2) age and female gender are associated with lower sodium concentration. Uncomplicated acute severe hypothyroidism didn’t cause clinically-important hyponatremia/SIADH in this cohort of patients.